Healthcare Provider Details

I. General information

NPI: 1821118993
Provider Name (Legal Business Name): MINIAN MARTIN YANG OTR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 THE CITY DR S
ORANGE CA
92868-3201
US

IV. Provider business mailing address

8051 WHITNEY DR
RIVERSIDE CA
92509-5207
US

V. Phone/Fax

Practice location:
  • Phone: 714-456-5957
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number474
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number474
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License Number474
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: